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Skeptical About Psychology for Chronic Pain? This Episode Will Change Your Mind | Sophie O'Dwyer
87 Plays3 days ago
Got a sore back and rolling your eyes at the idea of "seeing a psychologist for it"? You're not alone and this episode is for you.
Lachlan puts that exact skepticism to pain psychologist Sophie and what follows is a masterclass in the real, physiological role psychology plays in persistent pain. They unpack the "window of tolerance," why the nervous system can become overprotective, how adverse life experiences shape our pain response and why phantom limb pain proves pain is never just about tissue damage.
From practical tools - progressive muscle relaxation, the stress bucket analogy, graded exposure, CBT, ACT and pain reprocessing therapy - to the bigger picture of why multidisciplinary care changes outcomes, this conversation bridges the physical and psychological divide that so many pain patients get stuck in.
Lachlan and Sophie also share the story behind Paced Health, their new multidisciplinary telehealth pain clinic - why they built it, what the name means, and how they're trying to fix the fragmented, confusing experience so many people with chronic pain describe.
RESOURCES:
- Pain Coach: Clinical software helping clinicians turn complex chronic pain into
simple habit targets. Sign-up here: https://paincoach.co
- Paced Health website: https://www.pacedhealth.com
- Paced Health Instagram: https://www.instagram.com/pacedhealth/
KEY TOPICS:
00:00 – Cold open: "Can psychology really help my back pain?"
01:00 – Meet Sophie, pain psychologist at Managing Pain
01:36 – Why a psych referral for pain feels invalidating — and how to start
03:17 – Noticing patterns: what pain psychologists actually look for
04:34 – What is nervous system regulation? The "window of tolerance"
06:35 – Signs you're in hyperarousal (fight-or-flight)
07:48 – Signs you're in hypoarousal (shutdown/freeze)
10:13 – How adverse childhood experiences shape your nervous system
12:46 – Complex trauma vs. single-event trauma
16:20 – Why do some people develop PTSD (and pain) — and others don't?
18:43 – How to actually widen your window of tolerance
20:33 – Allostatic load and the "stress bucket" analogy
22:00 – Doing hard things on purpose: habituation and control
27:11 – Phantom limb pain: proof pain isn't just physical
28:31 – Practical tools: breathing, PMR, mindfulness
30:31 – Cognitive functional therapy & movement experiments
33:29 – CBT and Acceptance and Commitment Therapy for pain
35:13 – What is Pain Reprocessing Therapy?
37:17 – Why multidisciplinary teams change outcomes
39:17 – The Paced Health origin story
42:05 – The idea: multiple clinicians, one room, one hour
44:12 – Why the name "Paced Health"?
47:09 – The Tour de France analogy for pacing
49:13 – Why build this business at all?
51:07 – How to get involved (clients + clinicians)
52:13 – Advice for someone at their lowest point with pain
54:27 – Closing thoughts: autonomy, hope, and community
Disclaimer: This podcast is not personalised medical advice. Please consult a health professional before acting on anything discussed.
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Transcript
00:00:00
Speaker
I've got a sore back. I'm a little bit skeptical as to the role of psychology when it comes to my very physical pain problem that feels like it's very centered to my lower back.
00:00:14
Speaker
How would you explain the role of psychology and how you could help? Great question.
00:00:22
Speaker
This podcast is not personalized medical advice. Consult a health professional before acting on anything discussed. Just give me 30 seconds before we start. Whether you're a clinician wanting better outcomes for your patients, someone living with chronic pain, or supporting someone who is, thank you for being a loyal listener.
00:00:42
Speaker
Most regular listeners haven't hit follow yet. If that's you, please tap it now. It tells the algorithm to show this to more people it can help. And that's the single biggest thing you can do to help me and my guests on our mission to create a world with a little less pain.
00:01:00
Speaker
Sophie, you and I work together at Managing Pain. You have long wait lists as a pain psychologist and you don't need to convince me how important your role is in in pain and the patients that you work with.
00:01:17
Speaker
But just assume that I'm coming in, I've got ah i've got a sore back. I'm a little bit skeptical as to the role of psychology when it comes to my very physical pain problem that feels like, know, it's very centered to my lower back.
00:01:36
Speaker
How would you explain the role of psychology and how you could help Great question. And obviously it can feel quite confusing or threatening or invalidating to receive a psych referral for for pain, for back pain, for chronic pain. um so yeah, I think for me just like forming a connection with someone, building rapport and a relationship is the first starting point, I guess, as it would be in any psychology session. um but yeah, yeah.
00:02:08
Speaker
I think um initially just supporting that person to feel like I'm on their side. I'm, um you know, like believing what they're telling me. I'm hearing their story. um And yeah, just kind of understanding like their perspective of it. You know, they might've heard multiple different um views or opinions from the health professionals they've seen, but that,
00:02:35
Speaker
doesn't always match how the person kind of sees that that story for themselves. So understanding like the you know, the experience from their perspective um just as a starting point to sort of see like how I can meet them where they're at in making sense of what they're experiencing.
00:02:54
Speaker
ah Yeah, that's huge. And it's definitely an important starting point. Okay, so imagine I, i like you. um ah I think you believe me. You've I feel like validated what, but I'm still like, what what are you what are you going to do for me? How how would you help me? um Yeah, how would you explain that?
00:03:17
Speaker
Yeah, so um you know, where you and I work at Managing Pain, we've got the pain specialists and and doctors on site. We've got um access to those case notes. So it's helpful for me to, again, see, like, what's going on for that person in terms of their their pain and their injury. um And usually if they've been referred to a psychologist, you know, there might be some you know, like a nervous system component or a stress component or something more going on, explaining their pain more than just the physical damage.
00:03:51
Speaker
um So usually I'd sort of approach it by helping that person to notice patterns in their own pain experience. Like have they noticed when they're not sleeping well or when they're more stressed, are they having more pain flares or um are there things that make their pain better or worse um that don't relate to, you know, new damage in their body? So helping them kind of notice those things for themselves. And then I'll kind of go in there with more of my own kind of education about it. m Yeah, that's awesome.
00:04:22
Speaker
what What is the role? You mentioned the nervous system and I think um nervous system regulation is like a bit of a buzzword that goes around. What is nervous system regulation?
00:04:34
Speaker
How can it um change someone's pain experience? Great question. so um like when I talk about the nervous system with clients, I'll often use stress like the analogy of window of tolerance where they've got kind of like a sweet spot in the middle, which is when you're within a comfortable zone of arousal. And then outside of that, you've got hyper arousal when you're in that fight or flight state and then hypo arousal beneath that when you're in like a numb, disconnected, flat, checked out space. So I'll often kind of going in quite early with this concept with clients to help them make sense of those different nervous system states
00:05:17
Speaker
because oftentimes um someone who is experiencing pain or stress or is dysregulated is spending quite a bit of time outside of that comfortable space. um Being in a lot of pain, not sleeping well, um experiencing trauma, are all things that can narrow your comfortable window. um so you know, many clients will report like, yeah, feeling quite on edge and irritable anxious, um you know, not sleeping well, all of those things which are, yeah, can be signs of being in that more kind of hyper alert, hyper aroused state. I'll usually share that education with clients, help them notice their own kind of signs of when they're in those different states and then ultimately, you know, what can we do to come back into that window when they've become dysregulated or how to to widen that.
00:06:11
Speaker
Hmm. it I feel like there's a there's a degree of awareness that has to come to be able to notice that you're in a in that kind of state. And i I find not everyone, that probably doesn't come naturally to everyone. What are some signs or what are some things that you could notice um that would show you that you're in the hyper arousal state?
00:06:35
Speaker
Yeah, great, um great question. And i do use a lot of like visuals with clients to help um help them understand these concepts. So something like a a map of the body and how the fight of or flight response shows up in in terms of like heart racing, feeling breathless, feeling hot and sweaty, like where in the different parts of the body can those signs show up? And these are these are things that overlap so much with like, yeah,
00:07:05
Speaker
you know, anything, you know, like feeling like your heart's racing or feeling sweaty or nauseous can happen for so many different reasons. But, um, I guess, yeah, educating someone like what to look out for and that kind of pattern of responses that can happen in the fight or flight state. Yeah. It can take time to connect like that to their their own experience and it's going to show up differently for different people, but it can be, um,
00:07:32
Speaker
like an eye-opening moment for someone to notice like, oh, you know, me like feeling nauseous or, you know, appetite loss and things like that could actually be related to, um you know, my stress or anxiety or trauma responses or something like that.
00:07:48
Speaker
ah And what about the the low state? So like the hyper arousal state, what are some signs for that state? Yeah, so um I guess like a common feature of both is feeling quite like disconnected from the present moment. So, um, yeah, in the hyper aroused state, it might be feeling like numb, dissociated, checked out with withdrawn flat.
00:08:16
Speaker
Um, some clients have shared things like, you know, hours might pass and they've not like been aware that that time has passed or yeah, feeling like a sense of just wanting to withdraw and hide away.
00:08:29
Speaker
ah And once they've once you've discovered these states, like how do you how do you link that to pain and how pain works and and um what role that might be playing in there their experience?
00:08:47
Speaker
Yeah, so um there's so many different avenues we can go depending on like if the person's got um like a trauma background, which...
00:08:57
Speaker
can often co-occur with pain or if someone's had a workplace injury and there's been a physical injury, but then like a psychological injury with that, um that window of tolerance can be very affected by like um trauma triggers and, um you know, more pain can come with that as well. But generally for someone experiencing pain, we'll often say like during a pain flare or a bad pain pain day,
00:09:28
Speaker
generally someone might say like, I just get more irritable, i'm more snappy at my family, um or I feel like I just can't be around anyone and starting to see more of those signs of like the same things are happening, happening during their day, but they're really kind of fluctuating outside of their window of tolerance. So, um,
00:09:48
Speaker
yeah, we can talk about like ways to kind of ground and regulate in those moments, but then also bigger picture, like how can we understand um the perent person's like patterns and behaviors around pain and managing pain flares to kind of reduce the frequency and intensity of of that where they're not, you know, hopefully having as many really bad pain days or pain flares.
00:10:13
Speaker
What is it? Like what influences someone's um yeah nervous system regulation? Like it I know that, for instance, with chronic pain, the the more adverse childhood events someone has, that the greater the likelihood that they might experience persistent pain in in later life.
00:10:36
Speaker
what What kind of shapes someone's nervous system and that window of tolerance? Totally. Yeah. So many things like from, from very early life can begin to shape that and, um, early experiences of feeling unsafe. Um, yeah, it is when the nervous system can learn to become overprotective. And it's those ways that we learn to cope early in life that, um, like in an unsafe or a challenging situation that can carry on
00:11:11
Speaker
carry through with us as we get older. So, um, yeah, we, and because of like the way our brains work, you know, we might continue to kind of seek out environments that feel familiar to that, um, as we get older. So it can be really difficult to, um, help the nervous system to recognize what feels safe or yeah, there's so so many factors that can influence that both in early life and then as we get older going through different life stressors um can for many people lead to a sense of feeling unsafe um or dysregulated. m And now what about like I guess big traumas like ah obviously
00:12:03
Speaker
i thought I don't like to really say it like that um because obviously there's there's so many different things that happen. But I guess what I'm saying is that like obviously it doesn't need to be this like massive thing. Sometimes it's just like these constant ways of moving through the world that people have that, you know, you might have it might have been very adaptive at the time.
00:12:25
Speaker
to, know, please everyone and and not, you know, make your requests and needs and and feelings known and and then you kind of develop that throughout life. but But what happens on like the the flip side where there is like a very traumatic event um which we see um often in the clinic?
00:12:46
Speaker
Yeah, um exactly. Well, like when it comes to a traumatic event, not everyone who experiences a traumatic event will necessarily go on to develop like PTSD or consequences from that. um But um yeah, it can show up in so many ways. Like um trauma can be, like you said, something that's um like with complex trauma, something that like there's been ah a series of ongoing traumas or yeah it can be a single event.
00:13:19
Speaker
um Usually like a single event trauma can sometimes be easier to, to treat in therapy. um And it always depends like what kind of, um you know, resources and protective factors that person's coming with as to what the impact of that single event trauma is, is going to be. And, you know, the access to therapy and things like that.
00:13:41
Speaker
um But yeah, it's, Interesting how that relates to, yeah, whether someone does go on to develop pain, you know, it's not necessarily always the case, but it can definitely predispose someone to having the type of nervous system that is more overprotective.
00:13:58
Speaker
the Yeah, you um after my last podcast, you sent through a message around that you you were quite interested in the discussion around PTSD, um sometimes leading to to physical like manifestations of pain within like a limb or whatever. Yeah.
00:14:18
Speaker
And sometimes not. And the question that I got from a psychiatrist was, you know, why don't all people with PTSD develop ah physical bodily pain? um Do you have any thoughts on that?
00:14:32
Speaker
Yeah, again, I wish I had, like, the answer to this question. I just think it's, like, it's just interesting to think about, like, all the factors that go into that. Like, again, just...
00:14:44
Speaker
um you know, like what are the protective factors that someone has in place? Like we talk about adverse childhood experiences, but like what what were like protective childhood experiences that that that person had that like buffered against it? Or um yeah, when it comes to like PTSD, what access to treatment did they have at the time? um What like other stressors were going on in their life? What resources did that person have? And i guess when it comes to like pain and trauma,
00:15:14
Speaker
These are things that can disproportionately impact people, you know, um dealing with like challenging life circumstances. So um yeah, there can be so many kind of like social factors or um yeah, like barriers when it comes to access to support that can unfortunately prolong or or amplify pain for some people.
00:15:36
Speaker
um Yeah. And I guess like, there's ah different ways that the nervous system becomes like heightened or overprotective and i guess pain is one of those ways but there's other symptoms of ptsd that also um exactly show signs of that kind of overprotective state so i guess it just can manifest in in different ways. And I think you kind of, Sean, like as I've reflected on that question, um talk to a bunch of people and as well as yourself, that's kind of where I've landed is like, we don't really know why some develop pain and others don't, but they develop some sort of protective output.
00:16:20
Speaker
And in this case, um in some cases that that protective output is, you physical embodied pain symptoms. I i want you to explain or at least your thoughts this might be something you can't answer as well exactly the way you know people like that you know yes no kind of answer um or that very black and white answer but why why do some people not develop um ptsd after a traumatic event do you have some thoughts around why that might be
00:17:00
Speaker
Yeah, I guess it like depends on the nature of the trauma and, life again, what you know happened in the person's life but before and at the time of it happening. um i recall from some PTSD training I did that you know women are more likely than men to go on to develop PTSD and particularly if it's an interpersonal trauma can um be like a ah type of trauma that can, yeah, be more likely to become PTSD.
00:17:33
Speaker
um So, yeah, i think I think that's a factor. And, um again, like what, yeah, sense of safety does the person already kind of have in their life when when the trauma occurs?
00:17:49
Speaker
If I'm seeing a client who, like, is is still in a situation that's quite, like, unsettled or and unstable it's going to be very difficult for um like for us to kind of work through that trauma until they can get to a place of kind of stabilization where we can start to form that distinction between like past and present so yeah in like the first phase of any trauma treatment it's reaching that place of safety and stabilization um and yeah like
00:18:23
Speaker
supporting the person to come back to window of tolerance, widen the window of cho tolerance, feel settled in the therapeutic relationship. um But yeah, like if the person's in a situation where there's still a sense of threat or dysregulation, it can be, um yeah, difficult for that to heal. Mm-hmm.
00:18:43
Speaker
how do you How does someone widen their their tolerance, their their window of tolerance? Because that like ah as someone that's quite you know driven and wants to like and make an impact or dent on the world, like it I think sometimes I definitely fall out of that window of tolerance. And like my my instinct is like didn't I'd still want to do so much. So it's like, can' I just like...
00:19:11
Speaker
become more resilient and like grow that window of tolerance? Is there, is there ways or is it kind of fixed? Yeah. So, um, I guess like but basic things like, um, you know, as best we can and kind of having good, like sleep and nutrition and social support, stable living environment and those sorts of things. Like, I guess all of us,
00:19:34
Speaker
you know, you get like hangry and irritable when you, you know, you've not eaten and or slept well. um So all of those like lifestyle factors make a difference. But um then it's, ah yeah, like having a good relationship with with your therapist, with your treating team. But, yeah, then also greater exposure and and gradually doing things that extend like towards the edge of that window and helping like your nervous a system to learn to cope in those situations. And I guess that like graded exposure approach is something that you probably use with your clients as well. Just like, you know, we can't go zero to a hundred and so relevant when it comes to pain, we have to kind of like, um, help like when it comes to increasing like movement or activity, do that in a gradual way. So your body and and your brain, your nervous system can learn to adjust. And it's the same when it comes to helping someone to,
00:20:33
Speaker
like widen that window of tolerance. It's doing that in a gradual way. m Yeah, we we we definitely use some very similar concepts, like one of them being allostatic load. um And, you know, I use like a bucket analogy and, you know, there's...
00:20:54
Speaker
From a mechanical, very our physical ah standpoint, we can, there's two options really when it comes to pain is we like, we reduce the load um so that your capacity is enough to withstand it um and your tolerance level is enough or, but we can't do that forever.
00:21:13
Speaker
um It's sometimes helpful early days, especially when you know pain is overwhelming. But at some stage, we kind of just need to get a bigger bucket. you know we need We need that to grow. um And like you say, there's ways to do that pacing, graded exposure, um which is yeah is actually quite a complicated task, especially i use things like steps and try to objectify it a little bit, but it can be quite challenging. um especially when I know as a physio that like it's not just the mechanical things that change the size of that bucket. um So like, yeah, I can focus on the the the physical load, but then there's all these other things that also contribute to to how how much tolerance they have.
00:22:00
Speaker
But i I want your thoughts on... when Because i I like doing things that are hard on purpose, um you know, like baths or whatever it may be. I like doing physically challenging things when I'm in control.
00:22:20
Speaker
And I feel like that, I'm wondering whether that grows our window of tolerance. Totally, yeah. Like for exposing ourselves to situations where we might become Yeah, like a little bit more dysregulated or it's outside of our comfort zone.
00:22:39
Speaker
There can be a process of habituation which occurs where, as you stay in that environment and don't avoid or escape it. our distress might escalate, but it's not necessarily going to stay that high indefinitely. We want to stay in that situation until it starts to come down. As long as it's like, you know, we're not too like completely overwhelmed or dysregulated. It's again, just like pushing outside, noticing that distress rise, staying in that situation and until it starts to settle. And then we might find the next time we do it, it's not kind of spiking as as high as it did that first time. and
00:23:16
Speaker
yeah, using, like, coping strategies to kind of, like, ride that out and and not leave straight away is a really great way of, like, helping nervous system assume to tolerate situations beyond, like, what it currently can.
00:23:31
Speaker
For sure. i think I wonder if there's a difference. I think there I think it's obvious like that there's a difference between whether you feel in control or not in that situation. Because, know, if I think if I use the ice bath analogy, like I can sit in there knowing that I could get out at any stage and like push myself to go a little longer.
00:23:51
Speaker
But if someone was holding me down, in the ice bath. It's a total different ballgame, right? So, yeah, I often encourage people to like to do some hard things that they feel like they're still in control. um And now, obviously, someone doesn't necessarily have to be holding us down to for us to feel out of control.
00:24:15
Speaker
um But it's kind of like teetering on the edge of of like where you feel you can do it, you can achieve it and you're you're in control of the situation.
00:24:26
Speaker
There's so many things that like modify the intensity or the challenge of these kind of exposure tasks. And for for so many people, um, some of the situations that feel most distressing are ones that like, um, ah where you,
00:24:45
Speaker
you know, we're kind of trying to tolerate like uncertainty or or like a lack of control um and predictability. So that can be like an important kind of thing to face to an extent like where it's still safe and when it's helping us.
00:25:01
Speaker
Yeah. What do you do when it's out of control? Like, Because I find that that's probably the hardest way like time for me to like regulate is when i'm when I'm like, okay, this thing's happening, it sucks, but I can't control it. Like because sometimes I'm in control and I'm a bit of a probably a control freak where I like to, you know, be able to change the trajectory of what's going on.
00:25:28
Speaker
And then there's sometimes there's situations that are like outside of me and then that that makes it more challenging. how how do you How would you approach that? Yeah, well, like usually, yeah, in psychology with graded exposure, it's just setting up kind of behavioural experiments to to test this out. It depends, like, what kind of uncertainties we're we're learning to tolerate. But I'm just trying to think of an example. like that Yeah, there's
00:25:59
Speaker
ah like there can be uncertainties or uncontrollable things just in terms of like how other people might perceive us or, um you know, like predicting what's going to happen in the future or or things like that. But, um you know, often in situations where we feel like not in control or vulnerable,
00:26:20
Speaker
We might have like safety behaviours or things we do to try and like self-soothe or regulate managing that. It might be like when you're in a social situation and feeling like not in control, maybe it's like going on your phone or doing something to kind of like um of avoid like the intensity of that experience for someone who's feeling like socially anxious, not being able to kind of predict and control how others are perceiving them.
00:26:46
Speaker
So often it's like noticing what are these kind of safety behaviours or things we do to like subtly avoid the intensity of that situation and like just gradually but um like reducing that or like facing the experience in in in its entirety, like dropping some of those safety behaviours. Yeah, interesting.
00:27:11
Speaker
Interesting. What, let's let's get practical now because ah I'm convinced that the nervous system is an important player in it and and the role of psychology on that. Actually, one thing that I say is um if we didn't have a nervous system, we wouldn't feel pain.
00:27:31
Speaker
And interestingly, if we don't have that limb that's painful, sometimes we still can feel pain. um And like, you know, that's that's phantom limb pain. And I find that,
00:27:44
Speaker
That little analogy actually can really help people to kind of grasp the idea of, okay, like pain is more than just the the body part. Like there's something bigger going on.
00:27:57
Speaker
um I'm convinced of that. So let's go to the practical. i hope everyone else is. um But if we go to if we go to practical things, like what do you what do you do as person pain psychologist is it just talk therapy or there are there strategies which I think is amazing by the way and I think education is such a big part of what we do but are there particular strategies that you use day to day yeah it's you know going to be so dependent and on like
00:28:31
Speaker
the person and, you know, my whole formulation of what's going on for them and what existing strategies they're coming with and all all of that. Um, but even just thinking about kind of like some of the core skills we teach in like our group program, for example, um, like there are, is a lot of benefit in relaxation techniques, breathing, progressive muscle relaxation, imagery, mindfulness, um, as a way to help, you know,
00:29:00
Speaker
increase a sense of like safety in the body, come back to a window of tolerance, reduce stress, um, improve sleep. Um, even like progressive muscle relaxation is actually one of my favorite techniques to introduce because so just briefly, it's for those who don't know, it's the tensing and releasing of muscles from head to toe, toe to head.
00:29:24
Speaker
um and that contrast between tension and release can just provide like a really nice immediate sense of relaxation and um whenever I do it I find myself just like yawning and becoming really relaxed like it's quite got a great evidence base for sleep and reducing stress and anxiety and all of that um but it can also yeah be so helpful just to for people to become a bit more aware of like when they are carrying tension in your body. So often for many of us, it's like, you might be kind of like hunching your shoulders or clenching your jaw or holding onto tension without realizing that you're doing it. And, um,
00:30:06
Speaker
doing an exercise like progressive muscle relaxation is just a really nice way of like becoming more in tune of those early signs of like stress or dysregulation or hyper arousal in your body as you are kind of becoming more tense or holding more of that. And having this as a tool to, to like release that, but also even just to kind of like drop your shoulders or exhale or help your body to feel a little bit more relaxed throughout the day. Yeah.
00:30:31
Speaker
m Yeah, that's that's fascinating. The reason it's fascinating, I use this therapy called cognitive functional therapy a lot. um Peter O'Sullivan's, you know, the main driver of that. um He's a leading researcher in lower back pain. And he talks about, like, you know protective behaviours and protective muscle guarding that goes on in chronic pain and and how to...
00:30:59
Speaker
how to how to reduce that. And I do look these little practical experiments with people with low back pain where I get them to try different movement experiments like one where like they'll breathe in through their nose and then as they're exhaling out through like a deep breath, they'll bend forward and we just compare like how does it feel when you do what you usually do versus like this technique.
00:31:21
Speaker
And You know, the theory around it is that that you know they're relaxing muscles in around that area, which allows them to move more freely. But I think there's probably a layer of like actually the nervous system component to the the deep breath that actually changes the interaction. But so many times people go, oh, wow, that's like that's so much better.
00:31:43
Speaker
And interesting what's interesting and um where I find it challenging is because, like, there's a long history of, like, posture, core strength, like making sure the back is stable and, like, it's this fragile, you know, body part, et cetera, which is just doesn't a hold much evidence.
00:32:05
Speaker
But, yeah, that actually... experimenting and them being able to experience that it goes so much further than me just explaining oh you know what core is a bit overrated like there's nothing wrong with your core strength but when they experience it it's a whole a whole different thing and yeah it's a it's a similar kind of idea maybe i should use the contract relax techniques as a movement experiment see how it goes Yeah, like another kind of like analogy I'll use is the one of the stress bucket where it's like,
00:32:40
Speaker
um you know, for for many people, we all have a different stress tolerance and that's represented by our stress bucket. um And we have, you know, warning signs of when that bucket's starting to fill up. Again, maybe noticing we're a bit more irritable or more tense or not sleeping as well.
00:32:59
Speaker
And we're very good at noticing when that bucket's like at peak or overflowing, everyone around us will obviously notice that. But it's kind of noticing like, again, those early warning signs of what that looks and feels like as that's building and just having tools to like, let some of that water out, which things like progressive muscle relaxation and and breath work are really good for, which is awesome. If you can kind of do that regularly as opposed to when we get to that, like overflow point, it can be a lot harder to use those techniques then.
00:33:29
Speaker
Are there any other practical techniques that you use kind of like that one? Yeah. So. just to kind of like tie this in with my broader approach. Um, like one of the best kind of like evidence-based therapies we have is cognitive behavioral therapy. That's got a great evidence base for chronic pain as well as acceptance and commitment therapy. There's other emerging ones as well. Um, but when it comes to to CBT, the, um, like thoughts and behaviors are such a big part of that. So,
00:34:02
Speaker
helping someone to notice like how they're responding to their pain um in terms of like thoughts and beliefs around it um Oftentimes there can be very worrying thoughts and beliefs about pain, like something seriously wrong or like I've done more damage or like this is just going to keep getting worse and worse, which can feel very stressful and overwhelming, um, and lead to behaviors like avoiding movement or, um, you know, avoiding seeing friends or doing things that you'd normally do. So, um, I think as psychologists, we have great tools to, to help people become more aware of those thought patterns and, um, tying in that psychoeducation around like, what have we,
00:34:49
Speaker
learn from, you know, your doctors and treating team about what's actually going in on in your body and how can we correct maybe some of these um inaccurate or unhelpful thoughts or beliefs about pain to respond in a way that feels more like safe and um and helpful to your body basically. oh Yeah, that's huge. What about um pain reprocessing therapy?
00:35:13
Speaker
There's been, you know, like I think that's probably a more... recent kind of development in this space can you explain what pain reprocessing therapy is and and what role you think it plays yeah so it's a newer um like therapy but has some great kind of initial evidence for the treatment of chronic pain particularly back pain um probably not as much yet as what we've got for like cbt and acceptance and commitment therapy but pain processing therapy is about um
00:35:48
Speaker
helping your your brain to attend to pain sensations through a lens of safety as opposed to threat when like, when we know that, you know, there is that nervous system component and the first component of the pain reprocessing therapy is psychoeducation. So kind of like what I'd mentioned earlier, helping the person to notice, like, is there evidence of my pain having nervous system component?
00:36:19
Speaker
what's this actually telling me? Is is my pain telling me that there is something seriously wrong or is this an overprotective nervous system? And similar to, you know, CBT and these other approaches, it's reframing thoughts around that it um and using things like mindfulness techniques to notice the pain and um approach it in a bit more of like a neutral way or through this new lens of safety as opposed to danger. so Yeah, pain reprocessing therapy incorporates these sorts of techniques um and, yeah, has really awesome results in the studies that that they have done. So, um yeah, it'll be interesting to see, um like, where it goes as more people start using it.
00:37:06
Speaker
Yeah, for sure, for sure. I can see the role that it could play, especially especially in that sort of more nervous system-driven type of pain. um Yeah, yeah.
00:37:17
Speaker
what What is the role of ah multidisciplinary teams when it comes to pain? Yeah, well, know, given that pain's biopsychosocial, it's, you know, it's not just or chronic pain. It's not just like a medical issue. There's other factors at play, hence why, you know, you and I work at a multidisciplinary pain clinic. There's a lot of evidence to suggest like this is best practice. And, you know, we can kind of see how that plays out in the work that that we do. It's awesome for for our clients to, know,
00:37:58
Speaker
have, you know, people who specialize in these different components of what they're experiencing that can collaborate and, um, come up with like a a shared plan and reinforce a consistent message. Cause obviously it can be so confusing. Um, when you, you know, you're only getting one piece of the puzzle or kind of mixed messages about what's going on. I think just having a cohesive understanding of what's happening in your body is kind of like a foundation for kind of, yeah, obviously knowing what to do about it and moving forward. So I think, yeah, it's awesome. Like in the work that we do, having the opportunity to to collaborate so easily, i think you definitely see the difference as opposed to, um yeah, working on your own in this space.
00:38:52
Speaker
Yeah, for sure. I'd say nearly every research article will start with pain is a biopsychosocial problem. It's has multi, it's multifactorial, etc. And then sometimes we just treat it like with one domain and it's like that doesn't that doesn't make sense of what we know the science is suggesting. Like you can't treat a multifactorial problem with a single solution.
00:39:17
Speaker
um I guess this is where our our paths have crossed and and we're building um something together do you want to introduce paste health and explain you know how this came to be yeah so um like lucky and i've been working together for a little while in you know multi-disciplinary team um on the gold coast as well as in our own private practice work we're both doing a fair bit of telehealth and
00:39:49
Speaker
realized, you know, we're both kind of doing this individually, but, um, you know, we're so aligned in what we're trying to do. Why not join forces and be able to offer something that is more multidisciplinary given what we know about, like, you know, what the research says and the outcomes that we see in clinical practice. so um, yeah, it's been awesome to join forces and, and create something together and, um,
00:40:18
Speaker
be able to kind of, um like the overall goal is to be able to connect more people to clinicians who have expertise in this area, who can, you know, willing to and can collaborate more easily, um as well as clinicians who really enjoy working in the space to be able to do that kind of work as well. So um yeah, it's been really rewarding to see this kind of come to life. We've we've launched um our telehealth service, Paced Health, in the last couple of weeks. And um we're bringing together pain psychologists, pain physios
00:40:55
Speaker
to to offer individual sessions, group programs, and, um you know, might kind of expand the services from from there as time goes on. But The vision is to, yeah, connect more people to the kind of care that we see having race benefit.
00:41:15
Speaker
Yeah, I when we met the first time ah to discuss, it was kind of a blank slate and we kind of just realised that we aligned on this fact that sometimes pain care is quite fragmented and, you know, they're getting advice from different health professionals that don't have the time, um the resources and and aren't kind of incentivized to to communicate well to to each other. um And the poor patient sometimes gets sort of stuck in the middle going, what's going on? I'm getting all these differing opinions and like what actually is is happening to me. And I think that's kind of where we where we aligned.
00:42:05
Speaker
And I remember saying to you, and I don't know whether this is you, I'm going to claim it that I came up with this, but it might it might have actually been you. But I think I was discussing to you, like, how would it be if we had multiple clinicians in an initial assessment for someone with persistent pain? So what if we had, like, a pain psychologist, a physio, a dietician, or a a pain specialist ah in the same room for an hour with the patient,
00:42:36
Speaker
um This was you, by the way. they Ah, yes, I can claim that. Okay, good. Great idea then, obviously. oh and and And you love the idea.
00:42:49
Speaker
you know, that is one of this one of the things that we have and We'd love to... We haven't had a patient choose this yet, um but that option of having, like, multiple professions within the same room to treat what is, like like you said, biopsychosocial problem with multiple contributing factors, um it just makes a lot of sense.
00:43:17
Speaker
Yeah, and... um to be able to give people the experience where they're not necessarily having to repeat the same information time and time again. for some people that can be distressing. it can be, um yeah, like,
00:43:35
Speaker
at times like a painful and emotional journey, um being able to kind of just tell that story once, know, you know, that's being heard by people who are validating, collaborating um and being able to like take that story from from different perspectives and then bring that together as like a shared um assessment and plan, i you know, I think may be valuable to some people who feel exhausted by the kind of hashing over um the same story and information in so many appointments.
00:44:12
Speaker
Yeah, I'm super excited to to make that happen and to to see it could it sort of come to fruition. I think it's ah i think it's a great idea, obviously. so Tell me um about the name Paste Health.
00:44:30
Speaker
So for those that are listening, I think it's probably important to to not assume but P-A-C-E-D. Yeah. tell us Tell us about the name and where that came from.
00:44:43
Speaker
Yeah. Well, you know, we've kind of touched on this in our chat today about, like, the role of pacing and kind of finding that sweet spot when it comes to, you know, activity and, um like,
00:44:58
Speaker
lifestyle when it comes to pain. Um, there can be those two ends of the spectrum when it comes to like withdrawal and avoidance when there's fear around movement or, um, more that kind of like boom and bust and, and pushing through and overdoing. So I found that, yeah, it was such a big part of my, my sessions is finding like the steps forward and the middle ground between all or nothing when it comes to like activity, when it comes to thought patterns and what that actually looks like in practice and seeing myself as someone who kind of like works alongside the person to map out those steps. so for me, the term paced is sort of like you're embodying that practice of pace pacing, which, you know, is not just something you do once it's a kind of like a way of living that, um, enables you to do things sustainably and it enables you to build up gradually and it's can be, you know, doing more and more, or it can also be pulling back and kind of like adding in those pauses during the day and emptying that bit of your stress bucket again. So you can do things in a sustainable way to prevent burnout, to prevent, you know, chronic stress and, and other health conditions that can come with that.
00:46:16
Speaker
yeah, Yeah, for me, it was just that ethos of like doing things in a sustainable way, your clinicians kind of working with you to to map out those sustainable steps.
00:46:27
Speaker
and Straight away, I loved the name, but I also had a little bit of a pushback. i was like because I was like, does it have some negative connotations that...
00:46:39
Speaker
you've got to slow down because um or kind of you feel like someone's like pulling the reins and and slowing you down and and as someone that does want to, you know, make an impact and is quite ambitious and has lived experience with pain, that kind of idea of being restricted or like limited um didn't sit doesn't sit right with me. And obviously that's not the the nature of the name or the reason behind the name.
00:47:09
Speaker
And a thought that sort of came to my mind as we've been discussing this and I've more and more liked the name is this. um I'm a big fan of the Tour de France cycling in general. um And ah it for those that haven't experienced it they you won't fully understand this, but the The lead rider is usually protected by the rest of the team. It's actually a very team sport rather than an individual sport because when you sit behind someone that's pacing you, um you're actually protected by the wind and you're there's less friction and you're able to move um at an easier but actually more sufficient efficient pace.
00:47:59
Speaker
And... these connotations kind of really align with the way that I feel my role is as a physiotherapist is like they're the they're the champion, they're the leader on the team.
00:48:12
Speaker
I'm there to so support them so that they can cross whatever their finish line is and, you know, win, um I guess, when it comes to to life with ah chronic pain.
00:48:26
Speaker
And I thought, man, it's It is such a cool name and I think there's so many different ways or analogies that you could explain it from, you different lenses that explain what we're trying to be about, which is collaborative, um,
00:48:44
Speaker
um supportive and know helping them along the journey um and I think yeah I think it encapsulates that so cool name that one's your name that that was your idea I'm glad that the cycling analogy finally got you on board yes yeah no I always liked the name but I was ah I was also just mindful of my own kind of like hunch with or or issues with sometimes that the idea of pacing.
00:49:13
Speaker
um What why why did you like business is not easy? I know that because I'm currently building two startups, which is probably not the wisest thing in the world. um But what what what is Yeah, why why did you choose to build this service and like what what motivates you?
00:49:39
Speaker
Yeah, I think, you know, just wanting to... um take what what I've sort of seen and observed and do things, um, in a new and different way, I guess. I know that there's a lot of people doing like awesome work in the chronic pain space. And I wanted to contribute to that. Um, I wanted to create opportunities for myself and others to do our, our best work, to be able to like work alongside clinicians who are like-minded and, um,
00:50:13
Speaker
create an experience for clients that, um yeah, create the best possible experience for clients. I've been, you know, doing my iron own thing for a little while um in my, like, own private practice and have been really enjoying that. But I just had, like, the biggest list of things that i wanted to, like,
00:50:36
Speaker
do and and it was always like okay when I get time I'll you know create these programs or I'll you know build these resources for my clients and i just realized like through creating a ah you know a team of people around me ah it's you know collectively we're going to be able to offer more than what I could do myself so um yeah I feel like I was kind of always headed in this direction and it's exciting for it to be coming to to life.
00:51:07
Speaker
Totally. Super exciting. is there Is there a way that people can learn more or um are we looking for, i kind of know the answers to these, but are we looking for other disciplines that might be interested in in working with us?
00:51:26
Speaker
Totally. Yeah. So, yeah, Well, firstly, our website is up, pastehealth.com, pastehealth on Instagram. um So on there you can find more about like our services and our approach and um our team and what we're offering. But, yeah, we are super excited for any potential, you know, clients to get in touch, referrers to get in touch. or clinicians who feel like this aligns with, you know, the work that they'd like to do in in this space, um whether that be psychologists, physios, dieticians, um or, you know, um GPs, pain physicians, we're, know, open to, yeah, to hearing from you and and building the team.
00:52:13
Speaker
Yeah, awesome. I have a question that I ask um regularly regularly on this show um and you'd be able to think of many clients.
00:52:24
Speaker
um But if you think of someone that's it's suffering, um that's at a very low point with their journey with persistent pain, what would your advice be to them?
00:52:37
Speaker
a Well, I think just that like, you know, you're not alone in that one in five Australians experience chronic pain.
00:52:49
Speaker
there can be so much of the stigma given, like, which is surprising given how common it is. um I think, like, many people feel alone in the experience. So um I think just, yeah, connecting with other people, like, being open with with friends and family about what you're experiencing can sometimes, like, reduce that isolation, which is why, i like,
00:53:17
Speaker
you know, with the group programs we do, it can be so nice to to see people feel like understood and less isolated in the experience. It is really, really tough, obviously. um But, yeah, I think just like finding the right people both in in your life and and treating teen to work with um makes such a big difference. Advocating for yourself if something doesn't feel right, getting a second opinion if something doesn't feel right, seeking out
00:53:48
Speaker
like a different psychologist or physio or whatever it might be if, if you know, you're not quite feeling it's the right fit with, with you know, your current person. um I think that just makes the biggest difference is like having the right support and and relationships around you amongst other things.
00:54:07
Speaker
Yeah, it's huge. Amongst other things, what are your other things? Oh,
00:54:14
Speaker
No, it's a great ah it's a great answer and very practical. And I think there's there's certain decisions that I think sometimes living with pain can feel like a little bit out of control.
00:54:27
Speaker
um And I think there is hope and there's like there's a sense of autonomy that can be regained. You know, you can choose certain things, um even if that is just the way that you respond to it, um or the team that you choose to have around you, which I think is something that you you pointed out. and that you're not alone, like lots of people experience this um and they come in all different personalities, yeah ethnicities, genders, et cetera.
00:55:01
Speaker
And there are people out there just like you that are experiencing it. I think that's really important advice. Well, thanks. Thanks, eve Sophie, for coming on. Thanks for having me.
00:55:14
Speaker
so Super practical, super helpful, um and I think the nervous system is no doubt a big part of chronic pain and and psychology can have an impact there. So thank thank you for sharing.
00:55:28
Speaker
Thank you so much.